• J. Cardiothorac. Vasc. Anesth. · Jun 2020

    Randomized Controlled Trial

    Does Intraoperative Cell Salvage Reduce Postoperative Infection Rates in Cardiac Surgery?

    • Jan van Klarenbosch, Edwin R van den Heuvel, Willem van Oeveren, and Adrianus J de Vries.
    • Department of Anesthesiology, University Medical Center Utrecht, Utrecht, the Netherlands. Electronic address: J.vanKlarenbosch@umcutrecht.nl.
    • J. Cardiothorac. Vasc. Anesth. 2020 Jun 1; 34 (6): 1457-1463.

    ObjectivePrimary outcome was the risk for infections after cell salvage in cardiac surgery.DesignData of a randomized controlled trial on cell salvage and filter use (ISRCTN58333401).SettingSix cardiac surgery centers in the Netherlands.ParticipantsAll 716 patients undergoing elective coronary artery bypass grafting, valve surgery, or combined procedures over a 4-year period who completed the trial.InterventionsPostoperative infection data were assessed according to Centre of Disease Control and Prevention/National Healthcare Safety Network surveillance definitions.Measurements And Main ResultsFifty-eight (15.9%) patients with cell salvage had infections, compared with 46 (13.1%) control patients. Mediation analysis was performed to estimate the direct effect of cell salvage on infections (OR 2.291 [1.177;4.460], p = 0.015) and the indirect effects of allogeneic transfusion and processed cell salvage blood on infections. Correction for confounders, including age, seks and body mass index was performed. Allogeneic transfusion had a direct effect on infections (OR = 2.082 [1.133;3.828], p = 0.018), but processed cell salvage blood did not (OR = 0.999 [0.999; 1.001], p = 0.089). There was a positive direct effect of cell salvage on allogeneic transfusion (OR = 0.275 [0.176;0.432], p < 0.001), but a negative direct effect of processed cell salvage blood (1.001 [1.001;1.002], p < 0.001) on allogeneic transfusion. Finally, there was a positive direct effect of cell salvage on the amount of processed blood.ConclusionsCell salvage was directly associated with higher infection rates, but this direct effect was almost completely eliminated by its indirect protective effect through reduced allogeneic blood transfusion.Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.

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